Office of Inspector General (OIG) Work Plan
Physician OIG Work Plan for 2009
Medicare Payments for Colonoscopy Services.
Medicare Payments for Unlisted Procedure Codes.
Medicare Billings with Modifier –GY.
Hospital OIG Work Plan for 2009
Reliability of Hospital-Reported Quality Measure Data.
Changes Under the MS-DRG System
Serious Medical Errors ("Never Events")
Healthcare News
Healthcare Services
Our Healthcare experts specialize in strategic planning, organizational development, physician compliance programs, HIPAA updates, facilities management, auditing services, and tax services.
Amper is one of the largest independent CPA,
accounting,
tax preparation, and
auditing firms in the New Jersey, Pennsylvania and New York region.
Presented by
Amper’s Healthcare Services Group
Physician OIG Work Plan for 2009
- Medicare Payments for Colonoscopy Services
- A colonoscopy may include biopsies to remove polyps, tumors, or other lesions
- Consultations/office visits may also be required
- OIG to determine if colonoscopy was properly supported, billed & paid in accordance with Medicare requirements
- Outpatient Physical Therapy Services Provided by Independent Therapists
- Focusing on independent therapists that have a high utilization rate for outpatient therapy services
- Review that services were medically necessary & properly documented
- Medicare Payments for Unlisted Procedure Codes
- Review provider usage of unlisted procedure codes
- Subject to individual review and manual pricing
- Medicare Billings with Modifier –GY
- -GY Modifier
- Services not covered by Medicare
- Medicare beneficiaries are acquiring large medical bills that they are responsible for paying
- OIG examining patterns & trends for physicians & suppliers utilizing modifier -GY
Hospital OIG Work Plan for 2009
- Reliability of Hospital-Reported Quality Measure Data
- Will review hospitals’ controls for ensuring accuracy of data related to quality of care that they submit to CMS for Medicare reimbursement
- Will determine whether hospitals have implemented sufficient controls to ensure their quality measurement data is valid
- Provider Bad Debts
- Will determine whether bad debt payments were appropriate under Medicare regulations
- Will determine if recoveries of prior year writeoffs were properly used to reduce the cost of beneficiary services for the period in which the recoveries were made
- Coding & Documentation Changes Under the MS-DRG System
- Will examine coding trends & patterns under the new system to determine whether certain MS-DRG’s are vulnerable to potential upcoding
- Serious Medical Errors (“Never Events”)
- Will review hospitals’ compliance with CMS requirements by identifying several hospital-acquired conditions using the Present on Admission coding system
Michael McLafferty CPA, MBA, CHFP, FACMPE
Partner, Healthcare Services Group
Email
732-287-1000 Ext. 1284
|
Print this issue
View as PDF